In School COVID 19 Vaccinations

The Florida Department of Health in Broward County (DOH-Broward) is one of 67 Public Health Departments under the governance of the integrated Florida Department of Health (DOH). Although DOH-Broward is a state agency, it maintains a very strong partnership with Broward County Government, which is formalized in a core contract. The main administrative campus is in Fort Lauderdale, Florida, with additional facilities in geographically accessible locations.  DOH-Broward is responsible for protecting, promoting, and improving the health of the county's 1.9 million residents and over 10 million annual visitors. 

According to the U.S. Census population estimates for July 2021, Broward County is the 17th most populous in the United States, with over 1.94 million people and 9% of Florida's residents. 34.1% of residents are foreign-born. The population is increasingly diverse with significant growth among minority racial and ethnic groups. Among Broward residents, 63.1% identify as White; 30.2% Black or African American including many who immigrated from Haiti, Jamaica, and other parts of the Caribbean, as well as Central and South America. 31.1 % of the population identifies as Hispanic or Latino. 37.5% of the population speaks a language other than English in the home.

In response to the SARS-CoV-2 (COVID-19) pandemic, DOH-Broward provided in-school Pfizer - BioNTech COVID-19 vaccinations to mitigate the spread within Broward County Public Schools (BCPS) including Elementary, Middle, High, Combination and Centers. BCPS is the sixth-largest school district in the nation and the second largest in the state of Florida. Each year, BCPS serves more than 256,000 students in 240 schools, centers, and technical colleges.  BCPS supports a diverse student population, representing 170 difference countries, speaking 147 languages.

Upon approval from the U.S. Food and Drug Administration (FDA) to administer vaccines in children 12 and older, DOH-Broward met with BCPS to develop and implement a mass vaccination project within local schools. Through a collaborative planning process, DOH-Broward and BCPS met with all school principals to provide information regarding the project. The initial meeting covered vaccine storage and handling, logistics, and points of contacts for each location. The logistics of the project included designated loading areas for couriers delivering and picking up vaccines each day, space within each school equipped to handle registration, vaccination administration, and observation.

During phase one of this vaccination project (May 2021-July 2021, September 2021-October 2021), following the FDA emergency use authorization (EUA) of the Pfizer - BioNTech COVID-19 vaccine for individuals ages 12 and over, DOH-Broward provided vaccines to students in all BCPS middle, high, combination schools and centers. Phase one consisted of two operational periods. During the initial 12-week period, at the end of the 2020-2021 school year (May 2021-July 2021), DOH-Broward provided 7,452 vaccines. During the following 7-week period, at the beginning of the 2021-2022 school year (September 2021-October 2021), DOH-Broward provided 2,754 vaccines. During each period of phase one, DOH-Broward provided Pfizer - BioNTech COVID-19 vaccinations at 35 middle schools, 32 high schools, 9 combination schools and 17 centers. Each period required administration of two rounds of the primary series of the Pfizer & BioNTech COVID-19 vaccine, thus requiring DOH-Broward vaccination teams to return to each school approximately 4 weeks after the initial vaccination event. This initial phase was modeled in an expanded mass vaccination project (phase two) which provided vaccinations for students ages 5 and over upon the FDA EUA of the Pfizer - BioNTech COVID-19 vaccine for individuals ages 5 and over.

Phase two of this vaccination project (November 2021-January 2022, March 2022-June 2022) following the FDA EUA of the Pfizer - BioNTech COVID-19 vaccine for individuals ages 5 and over, DOH-Broward provided vaccines to students in all BCPS elementary, middle, high, combination schools and centers.

This phase consisted of two operational periods. During the initial 6-week period, DOH-Broward provided the Pfizer - BioNTech COVID-19 vaccine at all 137 elementary schools. During the following 14-week period, DOH-Broward returned to all 137 elementary schools, 35 middle schools, 32 high schools, 9 combination schools and 17 centers. During both operational periods of phase two, DOH-Broward simultaneously mobilized vaccination operations at up to 13 schools per day.

The primary objective of this practice was to ensure equitable access to the COVID-19 vaccine, without barriers, by providing multiple opportunities for BCPS students to receive this vaccine. DOH-Broward achieved this objective by providing COVID-19 vaccinations at each elementary school on 4 separate occasions, at each middle school on 6 separate occasions and at each high school, combination school and center on 4 separate occasions. At the conclusion of the project, schools were provided with current information on resources within the local community to receive additional COVID-19 vaccines.

DOH-Broward administered over 46,214 vaccines to students within BCPS through the successful efforts of this in-school vaccination project. 

Webpage:   Florida Department of Health in Broward (floridahealth.gov)

DOH-Broward implemented a mass vaccination project through an equitable approach by removing barriers for vaccinations for all families. DOH-Broward wanted to ensure students continued to receive in-person instruction in all schools and were able to receive their COVID-19 vaccinations without barriers.  In order to achieve this, DOH-Broward went to every BCPS offering free vaccinations during and after school to remove potential barriers to vaccination access. 

Of the 240 BCPS, 179 of the schools provide both free breakfast and lunch to all students due to the eligibility of the students in these schools.  In addition, 106 of 137 elementary schools and 31 of 35 middle schools are Title 1 schools.  Title I is a federally funded program for economically disadvantaged children who reside in school attendance areas with a high concentration of children from low-income families.

Providing vaccinations in all schools ensured parents did not have to take time off from work, unless they chose to vaccinate their student during after school hours, and provided access to students who may not have a physician at a place that was convenient and known to the families.  In addition, according to The Lancet Regional Health Americas, school based-vaccination programs are instrumental in increasing uptake among adolescents for multiple routinely recommended vaccines and are acceptable to parents.  School-based vaccine programs also reduce inequities experienced by those from marginalized groups.

DOH-Broward reached all 240 public schools and provided over 46,214 vaccines in the schools.   

DOH-Broward and BCPS has a joint responsibility to provide mandated health services in all public schools. The current School Health Services Plan developed by DOH-Broward and BCPS outlines the need for prevention strategies in the presence of any communicable disease for which immunization is required. DOH-Broward collaborated with BCPS administration and individual school principals to implement a mass vaccination project to mitigate the spread of the SARS-CoV-2 infection (COVID-19).  Pfizer - BioNTech COVID-19 vaccines were provided within all BCPS including elementary, middle, high, combination and centers.

DOH-Broward met with BCPS administration and provided information at an all principals meeting and then met individually with school principals during the planning phase of the project.  During this meeting, DOH-Broward outlined an operational plan that included procedures for staffing, transportation of vaccines, communications to families, and logistical support needed from BCPS at each school.  BCPS agreed to provide a designated point of contact at each school, facilitate communications to families, distribute consent forms to all applicable students, collect completed/signed consent forms, and designate a space onsite at each school to administer vaccines. The supplies and resources provided by DOH-Broward for this practice included staffing (site managers, nurses, staff assistants), the Pfizer- BioNTech COVID-19 vaccine, coolers for proper storage and handling of vaccines, ancillary supplies, directional event signage, physical copies of consent forms, EUA fact sheets, and community resources.

Prior to the implementation phase, DOH-Broward staff assigned to this practice completed a comprehensive training on the operational processes and procedures. DOH-Broward nurses assigned to this practice completed an additional comprehensive Pfizer-BioNTech COVID-19 vaccine training program developed by the DOH-Broward Director of Nursing, which focused on vaccine administration and vaccine storage/handling procedures.

DOH-Broward established approximately 13 in-school vaccination teams, comprised of DOH-Broward staff, which were deployed to in-school vaccination events daily for the duration of this practice. Each vaccination team was assigned a point of dispensing (POD) manager to oversee the entire process, direct staff in all roles, and mitigate any issues. The POD manager was also responsible for communicating with the established BCPS point of contact at each school and the Operations Chief at DOH-Broward. Clerical staff were assigned to each vaccination team to assist with client registration, pre-screening of consent forms and distribute community resources to families. Registered nurses and licensed practical nurses (LPNs) were assigned to each vaccination team to reconstitute the Pfizer - BioNTech COVID-19 vaccine, administer the Pfizer - BioNTech COVID-19 vaccine, and provide post-vaccination medical observation of clients for 15-30 minutes as recommended by the applicable administering nurse.  Couriers were assigned to each vaccination team to transport the Pfizer -BioNTech COVID-19 vaccines and all necessary supplies provided by DOH-Broward for the successful operation of the vaccination event. Couriers were responsible for the timely delivery of the supplies to the vaccination event, assisting with the set-up and breakdown of the vaccination event and returning the supplies to the warehouse after the event has been demobilized.

Prior to DOH-Broward arriving to administer vaccines, each school was responsible for notifying parents through parent links (robo-calls) and by sending consent forms home for vaccine administration. For each school, an individual parent link was developed and disseminated one week prior to each school's vaccination event and then again, the day before the scheduled vaccination event. Schools provided families with the COVID-19 vaccination date information as well as physical copies of consent forms and the EUA fact sheet. BCPS and DOH-Broward provided links on their respective websites for families to access digital copies of the consent form and the EUA fact sheet. Consent forms were provided in multiple languages to accommodate Broward County's diverse population.

Approximately one week prior to the scheduled vaccination event date, the POD manager confirmed the event details and logistics with the identified BCPS point of contact at each school. Upon arrival at the school, the POD manager would meet with the BCPS point of contact and tour the space designated by the school for the vaccination event. After the POD manager confirmed the designated space was equipped to support operations throughout the operational period, staff were directed to set-up for the event. During the set-up period, for vaccination events held during the school day, the BCPS point of contact would provide the POD manager with all signed consent forms collected by the school in advance of the vaccination event. After completing the event set-up, the vaccination team would begin the pre-screening process. DOH-Broward implemented a comprehensive four-tier pre-screening process to ensure that students were receiving the appropriate vaccine within the timeframe outlined by current guidelines established by the Centers for Disease Control and Prevention (CDC). This process required two clerical staff members, the POD manager, and a designated registered nurse to independently screen each of the signed consent forms for completion of all applicable information and signatures, then verify vaccine status of each student by utilizing the Florida SHOTS database. Florida SHOTS (State Health Online Tracking System) is a free, statewide, centralized online immunization registry that assists health care providers, schools, and parents with keeping track of immunization records. After completing the pre-screening process, when applicable, the POD manager would notify the BCPS point of contact to begin sending students to the designated vaccination location. After each vaccine was administered, students were sent to the post-vaccination observation nurse to be monitored for any adverse reactions for 15-30 minutes as recommended by the applicable administering nurse.

The goal of providing in-school COVID-19 vaccinations was to ensure there were no barriers for families and children to receive their COVID-19 vaccines. This practice proved to be effective as we met our objective of offering vaccinations in all 240 public schools, with vaccination opportunities offered both during the school day and after school hours.  DOH-Broward provided over 46,214 vaccinations in Broward County Public Schools during the practice period.

At the end of each operational period, POD Managers were required to complete a situation report to recount daily operations. All situation reports were submitted to a central repository to accumulate the total number of vaccinations provided, and on-site staff entered the vaccinations into the Florida SHOTS database.

105 of 131 elementary schools and 31 of 35 middle schools in Broward County are Title 1 schools.  Title 1 is a federally funded program for economically disadvantaged children who reside in school attendance areas with a high concentration of children from low-income families. 45,686 children in Broward County were uninsured in 2019.  The COVID-19 in-school vaccination practice afforded children an opportunity to be vaccinated at a time and place that was convenient for families and was made accessible for those children without a medical home.

The in-school vaccination project can be scaled by vaccination teams and applicable resources based on the scope of the project. The scalability of the vaccination teams and resources can be observed between phase one and two of this practice. While the in-school vaccination project outlined in this practice was scaled to serve as a mass vaccination effort, the scalability allows it to be utilized in a variety of community vaccination efforts. Additionally, the limited resources required to operate this practice are utilized in the day-to-day operations of vaccination outreach efforts. This allows for this practice to be quickly mobilized when required or implemented as an annual in-school immunization program, providing equitable access to all required and recommended vaccines for school age children.

Local pharmacies, hospitals, and community organizations are currently providing COVID-19 vaccines.  DOH-Broward continues to provide vaccinations as part of our immunization clinic for children of all ages.